When a woman aborts a single fetus, that abortion can be a morally troubling experience for her. What about a situation in which a woman is pregnant with more than one fetus, perhaps identical twins, and wishes to abort just one of them – that is, engage in what is sometimes called ‘fetal reduction’ in a ‘multiple pregnancy’? Continue reading →

On July 30, The UK’s Supreme Court ruled that there is no requirement to obtain court approval before withdrawing clinically assisted nutrition and hydration (CANH), when there is agreement between physicians and the family that this is in the best interests of the patient.

In the judgement, Lady Black writes:

“If the provisions of the MCA [Mental Capacity Act] 2005 are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

Until now, requests to withdraw CANH needed to be heard by the Court of Protection to determine if withdrawing treatment was in the patient’s best interest. In addition to being emotionally difficult for families, this is a time-consuming and expensive process, and often results in the patient dying before a judgement is rendered.

I think this decision has much to be said in its favour. First, it means that when there is agreement that continued treatment is no longer in the best interests of a patient with a prolonged disorder of consciousness, these patients are no longer being ‘forced to live’ until the Court affirms that being allowed to die is in their best interests. In many cases, court decisions take months, meaning that a patient is forced to be kept alive, against their best interests and the wishes of their family. Making the decision to withdraw care from a loved one is highly distressing, and this is likely further compounded by the burden and distraction of court proceedings.

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests. Continue reading →

Measles is making a comeback in Britain and Europe with numbers rising to record levels this year. Last year in Europe, measles killed 35 people, including young children . The re-emergence of measles can be traced to falling rates of vaccination and might make you want to re-think your summer plans. Crowded environments with low levels of hygiene, also known as summer festivals, are something to avoid if unsure about whether you have been properly vaccinated. And maybe re-think going for holidays to Romania, Italy and Greece, the countries with the highest rates of measles outbreaks this year.

But of course, even if you are not vaccinated, your chances of getting measles are low. And if you are infected, dying from measles is rare. The people that die during measles outbreaks are vulnerable babies that are too young to be vaccinated and unvaccinated people with compromised immune systems. And what are the chances that you infect one of these vulnerable people? Extremely low. Your intuition then might be that even if you are unsure about your vaccination status, the low odds don’t seem to justify the effort to engage with the NHS or any other health care provider. Maximize your benefits, and others will surely be fine. Individually, this feels right, but for the communities and countries we live in, this is disastrous, slowly eroding herd immunity that protects the most vulnerable.

What happens after we die? This might be taken as an eschatological question, seeking some explanation or reassurance around the destiny of an immortal soul or some such vital element of our very being. But there is another sense that has at least as much importance. What should we do with dead bodies?

According to a Yougov survey from 2016, a majority of UK residents prefer cremation over burial, with their ashes scattered in some meaningful place. This could be good news, given the apparent dwindling of burial space globally. In the face of this sort of constraint, the re-use of graves becomes necessary, which can cause distress to the families of even the long dead.

Less commonly, dead bodies can be donated to medical science and put to use for purposes of research and medical training. Research suggests the rate is low owing to ‘non-cognitive factors’ such as ‘the desire to maintain bodily integrity, worries that signing a donor card might ‘jinx’ a person, and medical mistrust.’

Maybe we should think again about how we treat dead bodies. There could come a time when cremation and burial might be considered a waste of resources, given the uses to which cadavers can be put. One body can be used to train many surgeons in complex procedures by being pared into relevant sections – individual limbs, organ systems, brains. Nevertheless, whilst a corpse is indeed a valuable object, it was also previously a subject. The nature of bodies as post-persons does seem to deserve some special consideration. If we can account for this, we might be in a position to recommend very generally why we ought to respect the bodies of the dead. Continue reading →

In the final lecture of the 2018 Uehiro lecture series, Richard Holton concluded his reflections on the theme of ‘illness and the social self’ by turning to questions about how attitudes can play a role in the onset of medical disorders, with a particular focus on psycho-somatic disorders.

Is discrimination against unattractive people (lookism) a serious problem? What are the costs of lookism ? What should we do about lookism? In this interview with Katrien Devolder, Dr Francesca Minerva (Philosopher, Ghent University) addresses these thorny questions.

The number of individuals suffering with dementia is steadily increasing; as such, the moral issues raised by the neurodegenerative diseases that bring about the symptoms typifying dementia are of pressing practical concern. In this context, Richard Holton’s topic for the first of his three 2018 Uehiro lectures (on the theme “Illness and the Social Self”) is a timely one: What are the ethical implications of the progressive and pervasive loss of memory that is a central feature of dementia?

I shall be blogging a synopsis of each lecture in the series on the Practical Ethics blog – You can find a recording of the lecture here

The development of accessible treatment options for pregnant women is a significant public health issue. Yet, very few medications are approved for use during pregnancy. Most drug labels have little data to inform prescribing decisions. This means that most medicines taken during pregnancy are used without data to guide safe and effective dosing.

The United States Food and Drug Administration recently published draft ethical guidelines for how and when to include pregnant women in drug development clinical trials. These guidelines call for “the judicious inclusion of pregnant women in clinical trials and careful attention to potential foetal risk”. The guidelines also distinguish between risks that are related to the research and those that are not, and the appropriate level of risk to which a foetus might be exposed. Continue reading →